A longitudinal investigation of medical student attitudes toward the medically indigent.

BACKGROUND: Studies have shown that medical student attitudes decline as students progress through school. Controversy persists about the meaning and generalizability of these findings because studies have not been longitudinal and many were conducted prior to an influx of female students. Much of medical education occurs in academic medical center environments where disproportionate numbers of indigent (uninsured and underinsured) patients seek care. This study examined whether students' attitudes toward providing care to indigent clientele changed over time. PURPOSE: To track longitudinal changes in attitudes toward providing care for the medically indigent of 1 cohort of medical students and to determine if gender differences existed and persisted over time. METHODS: Students entering a Southwest medical school in 1989 participated in this study. Attitudes were compared using the Medical Students' Attitudes Toward the Underserved questionnaire, a self-report, attitudinal scale. RESULTS: Student attitudes declined during the 1st year of school, remained fairly stable during Years 2 and 3, and declined further during Year 4. Analyses comparing 1st- and 4th-year students showed a decline in attitudes for men and women for each scale except Basic Services. Although both women's and men's attitudes declined, women's attitudes remained more favorable across the 4 years. CONCLUSIONS: A clearer understanding of how female medical students sustain socially responsible attitudes throughout medical school may help educators develop support mechanisms for men and women that would promote an ethic of social responsibility and encourage students to work with indigent clientele.

Medical students' attitudes toward providing care for the underserved. Are we training socially responsible physicians?

OBJECTIVE: To investigate the association between attitudes toward caring for the medically indigent and years of medical training. DESIGN: Questionnaire comparing attitudes of first-year medical students (MS-Is) and fourth-year medical students (MS-IVs). SETTING: Southwest medical school. PARTICIPANTS: A total of 83 (67%) male and 41 (33%) female MS-I and 65 (73%) male and 24 (27%) female MS-IV volunteers. MAIN OUTCOME MEASURE: Self-report, attitudinal scale developed for this study that provided a measure of overall attitudes, perceived societal expectations, physician/student responsibility, personal efficacy, and provision of basic services and expensive procedures. RESULTS: Overall attitudes were significantly less favorable for MS-IVs (95% confidence interval [CI], 99.6 to 106.2) than MS-Is (95% CI, 109.5 to 114.3, P < .0001). Except for basic services (P = .46), MS-IVs had worse attitudes on all attitudes subscales. Male MS-IVs reported significantly less favorable attitudes than male MS-Is in the areas of general attitudes (P = .03) and physician/student responsibility (P = .01). Female medical students showed no significant differences across classes (P > .05). Except for physician/student responsibility, female medical students' attitudes were more favorable than those of males, regardless of class. CONCLUSIONS: The MS-IVs are less favorably inclined toward caring for the medically indigent than MS-Is, though these differences are apparent only for males. Further research is needed to explore why females appear to be more resistant to attitude changes, and what educational interventions are necessary to better train physicians to respond to national health care issues.

Experience with mandatory continuing education in a teaching hospital.

Mandatory continuing education (MCE) has the potential to create unwilling learners who, if given a choice, may not participate in continuing education programs. Participants of two MCE programs conducted at a large teaching hospital responded to a survey assessing their perception of and attitudes toward MCE and their perceptions of program effectiveness. Results of the study indicated that mandating the programs did have adverse effects on participants' perceived outcomes and on the likelihood of their voluntarily attending future programs. Descriptions of the two programs, design and results of the study, and suggestions on how to approach mandatory programming are presented.

Employment freeze management: an approach to attaining retrenchment goals.

This article describes a management philosophy for retrenchment and down-sizing within a major health care institution. The author focuses on an unique approach for reducing staff to attain retrenchment goals in light of ever decreasing operating budgets, increased cost containment and accountability, and increased demands for productivity enhancement and service in a competitive customer-oriented health care market.